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We compared the efficacy of ACD-CPR and STD-CPR based on 64 multi-institutional reports. No significant differences were observed in the rate of restoration of spontaneous circulation (ROSC) and in cardiopulmonary parameters during CPR using the two methods. There were 5 cases in which cardiopulmonary parameters improved after switching from STD-CPR to ACD-CPR and, eventually, in two of them spontaneous circulation was restored. In the ROSC cases of both groups, ETCO2 and values of SpO2, PaO2, and systolic BP at 30 minutes were higher than those of non-ROSC cases. ETCO2 never exceeded 20 mmHg in the non-ROSC cases, but it was higher in the ROSC cases. ACD-CPR is a good choice when trained persons are present or when extra hands are available to continue the CPR.

We report a case of transfusion-associated graft-versus-host disease (GVHD). A 79-year-old woman with Hodgkin's disease, respiratory failure and severe anemia who had been treated with two courses of chemotherapy was transfused with red cell concentrate (MAP-CRC) and fresh frozen plasma (FFP) in the ICU. On the 7-9th days after transfusion, she developed a diffuse erythematous rash mainly on the chest, high fever, liver dysfunction and thrombocytopenia. Despite treatment with immunoglobulin products and methylprednisolone, her condition deteriorated rapidly, and she died of multiple organ failure on the 7th day after appearance of rash. Skin biopsy demonstrated typical features of acute GVHD, suggesting that MAP-CRC-associated GVHD had occurred.

The efficacy of a tele-ECG transmission system for transmission of electrocardiograms from ambulance to Osaka City University Hospital for 59 patients with out-of-hospital cardiac arrest was evaluated from December 1992 to November 1993. Authorized emergency life saving technicians (ELSTs) transmitted electrocardiograms by automobilephone connected with electrocardiogram from the location of out-of-hospital cardiac arrest recognized by them to the ICU. Successful tele-ECG transfer was achieved in 34 cases (57.6%). The most common reason for failure of transmission was interference by large buildings located in our urban location, which occurred in 12 of the 25 cases. Defibrillary shock was applied in 9 of 10 cases of ventricular fibrillation, and one patient among them could return to work. In most cases, laryngeal mask airway insertion was performed. The group with tele-ECG transmission required longer time for transfer to the hospital. The time required for insertion of the laryngeal mask airway and tele-ECG transmission appeared to be the main reason for the delay in transport. Although use of tele-ECG transmission can be useful for patients with out-of-hospital cardiac arrest, further improvement on the transmission system will be needed.

When postoperative radiotherapy for breast cancer is indicated, we employ a single large portal technique with electron beams using a bolus made of MIX-R (soft tissue equivalent material) for the chest wall. The entire lymph node groups as well as the chest wall are irradiated uniformly, and the total dose is 50 Gy, 2 Gy/fraction, 5 days/week. Radiation changes of the lung in 35 breast cancer patients irradiated by this technique were evaluated by computed tomographic (CT) studies. Radiation injuries were detected in 12 patients out of 35 (34%). Among patients who were irradiated by three portal techniques without bolus, radiation injuries were detected in all 4 patients (100%) by CT and in 39 patients out 72 (54%: historical control group) by plain chest film. These results indicated the superiority of the single large portal technique. Radiation injuries were identified in CT studies at 135 day after commencement of radiotherapy, and their distributions were localized to areas of 80-100% dose level. Measurements in CT revealed that the thickness of the chest wall varied extremely according to surgical procedures, so that the adequacy of the selection of energy of electron beams in each patient by CT was indispensable.